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ACU COURSE > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

When are pacemakers used?

A

To stimulate a patient’s heart when they are experiencing bradycardia and HR cannot be improved by drugs (ie - Atropine)

Most often used to treat symptomatic bradycardia

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2
Q

What are the two types of temporary pacemakers?

What is the difference?

When are they used?

A

Transcutaneous - emergency situations, short term, use pacer pads

Transvenous - pacer wires placed in RV (lose atrial kick), can be left in x1 week

Used for bradycardic arrhythmias (heart blocks)

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3
Q

What are the four types of permanent pacemakers?

A

Single - atrial or ventricular
Dual - atrial and ventricular
CRT - dilated cardiomyopathy
ICD - life-threatening arrhythmias (can pace and defibrillate as needed)

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4
Q

When is atrial pacing indicated?

A

SA node dysfunction, but normal AV conduction

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5
Q

When is ventricular pacing indicated?

A

Damaged ventricular response

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6
Q

What is CRT used for?

A

Dilated cardiomyopathy - improve CO

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7
Q

When is epicardial pacing used?

A

Major cardio/thoracic surgeries in case of post-op arrhythmias

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8
Q

Demand pacing

Non-demand pacing

Rate responsive pacing

A

Fires only when needed (HR falls below predetermined rate)

Fires at a predetermined rate whether it is needed or not

Will speed up or slow down depending on the patient’s level of activity

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9
Q

Fire

Capture

Sense

A

Pacemaker sent an impulse

Impulse resulted in contraction

Pacemaker can detect pt’s own beats
- High # = higher fence = low sensitivity (wont’s sense pt’s electrical activity)
- Low # = lower fence = high sensitivity (will sense too much of pt’s electrical activity

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10
Q

Under-sensing

A

Sensitivity set too low (high fence)

Cannot sense patient’s own electrical activity

Can cause lethal rhythms (R on T phenomenon)

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11
Q

Over-sensing

A

Sensitivity set too high (low fence)

Senses too much of the patient’s own electrical activity

Ie - may sense pt movement and not fire sensing it as cardiac activity

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12
Q

What to do if a permanent PM fails to fire?

A

Call MD STAT
Call for PM Magnet
Prep for TCP
Call EP team to assess PM fx

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13
Q

Loss of capture

A

Pacer spikes do not result in complex - not enough energy to cause depolarization

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14
Q

CAD: Progressive ___________ disorder of the coronary arteries that result in ________ or complete ________

A

CAD: Progressive ATHEROSCLEROTIC disorder of the coronary arteries that result in NARROWING or complete OCCULUSION

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15
Q

Atherosclerosis: ______ builds up in arteries, blocking blood flow. Caused by accumulation of _____, _____, and waste products. Mature ______ can crack/rupture resulting in ________ ________

A

Atherosclerosis: PLAQUE builds up in arteries, blocking blood flow. Caused by accumulation of CHOLESTEROL, FATS, and waste products. Mature PLAQUE can crack/rupture resulting in CLOT FORMATION

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16
Q

ACS is the _______ of atherosclerosis

It includes:

A

ACS is the MANIFESTATION of atherosclerosis

It includes: stable angina, unstable angina, NSTEMI, STEMI

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17
Q

Angina

A

Lack of oxygen to heart muscle which leads to chest pain, discomfort, and pressure

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18
Q

Typical Chest Pain

A

Heavy chest pressure and/or pain/heaviness
Radiates to neck, jaw, shoulder, arms, back
SOB
Nausea
Sweating
Light-headedness

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19
Q

Atypical Chest Pain

Who does it often affect?

A

Pleuritic pain
Abdominal pain
Radiates to lower ext

Often affects women, elderly, diabetic individuals

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20
Q

Stable Angina: ________ and ______ by similar precipitating factors

Typically _______ induced and lasts less than ___ mins and relieved by _____

Is it detected by ECG/cardiac biomarkers?

Treatment: AABCO

A

Stable Angina: PREDICTABLE and REPRODUCIBLE by similar precipitating factors

Typically EXERTION induced and lasts less than 5 mins and relieved by REST

Is it detected by ECG/cardiac biomarkers? - NO

Treatment: AABCO
- Aspirin
- ACE inhibitor
- BB
- Clopidogrel
- Oral nitrates

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21
Q

Unstable Angina: ______ chest pain that occurs at ____ and gets worse

Not relieved by _______ or ________

A

Unstable Angina: UNPREDICTABLE chest pain that occurs at REST and gets worse

Not relieved by medication or rest

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22
Q

All new CP or change in frequency is considered _______ and should be treated as a potential MI until more information is gathered

A

All new CP or change in frequency is considered UNSTABLE and should be treated as a potential MI until more information is gathered

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23
Q

Irreversible myocardial necrosis that results from abrupt decrease or total blockage of blood flow to cardiac tissue

Two types

A

MI

NSTEMI
STEMI

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24
Q

NSTEMI: ______ occlusion of CA

May or may not be ________

May see _______ ________ on ECG

Confirmed by _________ __________

A

NSTEMI: PARTIAL occlusion of CA

May or may not be SYMPTOMATIC

May see ST DEPRESSION on ECG

Confirmed by CARDIAC BIOMARKERS

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25
Q

Unstable Angina vs NSTEMI

Treatment is the ________
Goal is to ______ ________

Difference is the presence of ______ ________
NSTEMI has ischemia severe enough to cause ______ ________ which causes the release of ________ ________

A

Unstable Angina vs NSTEMI

Treatment is the SAME
Goal is to PREVENT PROGRESSION

Difference is the presence of CARDIAC BIOMARKERS
NSTEMI has ischemia severe enough to cause MYOCARDIAL INJURY which causes the release of CARDIAC BIOMARKERS

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26
Q

TROP VS CK

________ is more sensitive and specific to myocardial damage

Measured at _______ and q ______hrs until levels have peaked

If a patient has a 2nd episode of CP, it is easier to recognize with _____ as they come back to baseline quicker

_______ only stays elevated for 1-2 _____ wherease _____ stays elevated for 1-2 ____

A

TROP VS CK

TROP is more sensitive and specific to myocardial damage

Measured at PRESENTATION and q 3-6 until levels have peaked

If a patient has a 2nd episode of CP, it is easier to recognize with CK as they come back to baseline quicker

CK only stays elevated for 1-2 DAYS whereas TROP stays elevated for 1-2 WEEKS

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27
Q

Treatment for Unstable Angina/NSTEMI

Nitro: ____mg SL/spray - ___ doses max in ___ mins __ mins apart
Ask if they have taken ________
Contraindicated in patient with _________ MI

Morphine: When pain not relieved after ______

O2: For sats <_____ or ________

ASA: Given on ______ and continued; ______mg _____

BB: Reduced myocardial _____

CCB: Decreases ______, _______, and HR
Only for patients who do not respond to _____

A

Treatment for Unstable Angina/NSTEMI

Nitro: 0.4 SL/spray - 3 doses max in 15 mins 5 mins apart
Ask if they have taken VIAGRA
Contraindicated in patient with VENTRICULAR MI

Morphine: When pain not relieved after NITRO

O2: For sats <90 or RESP DISTRESS

ASA: Given on PRESENTATION and continued; 80-160 CHEWED

BB: Reduced myocardial CONTRACTILITY

CCB: Decreases AFTERLOAD, CONTRACTILITY, and HR
Only for patients who do not respond to BB

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28
Q

STEMI: Thrombus _________ occludes CA

If quickly identified and treated, myocardial injury can be _______

Main treatment goal is to ________ _________ via _____ or _______

A

STEMI: Thrombus COMPLETELY occludes CA

If quickly identified and treated, myocardial injury can be REVERSED

Main treatment goal is to RESTORE FLOW via PCI or FIBRINOLYTICS

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29
Q

PCI: Angioplasty and Stenting

Target time ________ minutes after symptoms

A

PCI: Angioplasty and Stenting

Target time < 90 minutes after symptoms

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30
Q

Fibrinolytic: Considered when _____ is not an option

Coming from another hospital without cath lab and treatment exceeds _______ minutes

______ is most common. Contraindicated with ________ and _________

A

Fibrinolytic: Considered when PCI is not an option

Coming from another hospital without cath lab and treatment exceeds > 120 minutes

TNK is most common. Contraindicated with UNSTABLE ANGINA and NSTEMI

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31
Q

Fibrinolytic contraindications

A

Intracerebral hemorrhage
Known aneurysm

Uncontrolled HTN
Oral anti-coagulants
Recent surgery/internal bleeding

anything that might cause bleeding

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32
Q

What drug should be avoided for STEMI?

A

NSAIDs and COX-2

33
Q

Patients who have survived a cardiac arrest and are comatose, should be assessed for _________, post PCI intervention

It can improve ______ outcome and survival post arrest

A

Patients who have survived a cardiac arrest and are comatose, should be assessed for TARGET TEMPERATURE MANAGEMENT, post PCI intervention

It can improve NEURO outcome and survival post-arrest

34
Q

PCI: Use to _____ and ______ partially or completely occluded coronary vessels

A _____ inserted and mobilized to the identified blockage in the CA

Once at the blockage site, ________ and ________ can occur

Major complication of angioplasty: immediate _________ of vessel, but done with ________ to prevent this

A

PCI: Use to TREAT and EVALUATE partially or completely occluded coronary vessels

A CATHETER inserted and mobilized to the identified blockage in the CA

Once at the blockage site, ANGIOPLASTY and STENTING can occur

Major complication of angioplasty: immediate RE-STENOSIS of vessel, but done with STENTING to prevent this

35
Q

Two Types of Stents:

Bare Metal Stent: Fewer _______ complications, but a higher incidence of _______ and rapid growth and spread of _______

Drug Eluting Stent: Have medication to inhibit ________ _________, decreased risk of ________, but increased risk of ______

A

Two Types of Stents:

Bare Metal Stent: Fewer THROMBOSIS complications, but a higher incidence of RE-STENOSIS and rapid growth and spread of CELLS

Drug Eluting Stent: Have medication to inhibit CELLULAR PROLIFERATION, decreased risk of RE-STENOSIS, but increased risk of THROMBOSIS

36
Q

PCI: Radial vs Femoral Approach

Which one is the standard? Why (x2)

Which one is used for extensive PAD?

A

PCI: Radial vs Femoral Approach

Radial - less bleeding, fewer activity limitations

Femoral

37
Q

PCI Nursing Management:

Monitor ____
Close ______ monitoring for reperfusion ______
Monitor _______ enzymes
Assess ______

A

PCI Nursing Management:

Monitor VS
Close TELEMETRY monitoring for reperfusion ARRHYTHMIAS
Monitor CARDIAC enzymes
Assess SITES, PERIPHERAL PULSES

38
Q

Coronary Artery Bypass Grafting

Surgical procedure where ___________ from another area of the body are _______ and used to create a ____ route for the hearts blood supply

Used when patients have ____ or more ______ arteries and severe left CAD

____________ procedure

A

Coronary Artery Bypass Grafting

Surgical procedure where BLOOD VESSELS from another area of the body are REMOVED and used to create a NEW route for the hearts blood supply

Used when patients have 3 or more STENOTIC arteries and severe left CAD

EMERGENT RESCUE procedure

39
Q

CABG Post-Op Nursing Management:

Assess ______
_______ pacing wires in-situ
Monitor ______ sites

A

CABG Post-Op Nursing Management:

Assess VS
EPICARDIAL pacing wires in-situ
Monitor GRAFT sites

40
Q

What is heart failure?

A

An issue with the heart muscle - not pumping effectively

Impairs the ability of the ventricle to fill/eject blood

41
Q

LS Heart Failure: Systolic Dysfunction

The inability of the ventricle to _______ properly - not ______ normally

Reduced _______

A

LS Heart Failure: Systolic Dysfunction

The inability of the ventricle to EMPTY properly - not CONTRACTING normally

Reduced EF

42
Q

LS Heart Failure: Diastolic Dysfunction

The inability of the ventricle to ______ properly - not _______ normally

Increased _______

A

LS Heart Failure: Diastolic Dysfunction

The inability of the ventricle to FILL properly - not RELAXING normally

Increased EF

43
Q

What type of symptoms do you have with LSHF?

A

Respiratory congestion - heart backing up into the lungs

SOB, orthopnea, crackles/wheezes, pink/frothy sputum, CP, confusion, S3/S4 sounds

44
Q

Which side of the stethoscope is used to listen to heart and lung sounds?

A

Diaphragm

45
Q

Where is the aortic sound heard?

A

R2ICS - sternal border

46
Q

Where is the pulmonic sound heard?

A

L2ICS - sternal border

47
Q

Where is the tricuspid sound heard?

A

L5ICS - sternal border

48
Q

Where is the bicuspid sound heart?

A

L5ICS - mid-clavicular

49
Q

Where is S1 heard?

A

Apex

50
Q

Where is S2 heard?

A

Base

51
Q

Which heart sounds best heard with bell?

A

S3/S4

52
Q

S3

A

Ventricular gallop

An excessive amount of blood enters ventricle quickly - dilated LV (overly-compliant) - systolic

53
Q

S4

A

Atrial gallop

Atria contract against stiff ventricle (non-compliant) - diastolic

54
Q

Left ventricle HF can lead to which arrhythmia?

A

Atrial fibrillation

55
Q

What is an LVAD?

A

A left ventricular assist device (LVAD) is implanted in the chest.

It helps pump blood from the lower left heart chamber (left ventricle) to the rest of the body

56
Q

What is an RVAD?

A

An external right ventricular assist device (RVAD) helps support the right ventricle’s function and pump blood to the lungs

57
Q

In patient’s with an LVAD/RVAD, patient’s do not have a ________ or ______

A

In patient’s with an LVAD/RVAD, patient’s do not have a PULSE or BP

58
Q

How to check if LVAD/RVAD is working?

A

A stethoscope should be placed over the apex of the heart to listen for a humming sound

Absence of a humming sound indicates that the LVAD is not working

59
Q

RS HF Manifestations

A

Weight gain
Edema
JVD
Ascites
Hepatomegaly

60
Q

RSHF Causes

A

LSHF
Pulmonic Valve Stenosis

61
Q

Last resort treatment for heart failure?

A

Heart transplant

62
Q

Cardiomyopathy: _______ and/or _______ dysfunction resulting in ventricular ______ or _________

A

Cardiomyopathy: ELECTRICAL and/or MECHANICAL dysfunction resulting in ventricular DILATION or HYPERTROPHY

63
Q

Cardiomyopathies:

Dilated

Hypertrophy

Restrictive

A

Cardiomyopathies:

Dilated - ventricular enlargement with thinning of the ventricular wall

Hypertrophy - thickening of the muscle wall

Restrictive - infiltration/fibrosis

64
Q

Preload and Afterload:

Preload is the initial _______ of the cardiac myocytes (muscle cells) prior to contraction. It is related to ventricular ________.

Afterload is the force or load against which the heart has to _______ to eject the blood.

A

Preload is the initial STRETCHING of the cardiac myocytes (muscle cells) prior to contraction. It is related to ventricular FILLING.

Afterload is the force or load against which the heart has to CONTRACT to eject the blood.

65
Q

Grading Valvular Disease:

Stages A-D

Stage D is when ________ develop

A

Grading Valvular Disease:

Stages A-D

Stage D is when SYMPTOMS develop

66
Q

Aortic Stenosis:

_______ of the aortic valve

Causes increased ______ resulting in left ventricular ___________

Will hear a systolic ________

Diagnosed using an ___________

Presence of ________ determines if stenosis is ________ or not

Medical management does not alter ___________, and is only used for ___________ _______

A

Aortic Stenosis:

NARROWING of the aortic valve

Causes increased AFTERLOAD resulting in left ventricular HYPERTROPHY

Will hear a systolic MURMUR

Diagnosed using an ECHO

Presence of SYMPTOMS determines if stenosis is SEVERE or not

Medical management does not alter PROGRESSION, and is only used for SYMPTOM RELIEF

67
Q

Which medication should be avoided in patients with aortic stenosis?

Which medications should be administered?

A

Beta-blockers - can worsen

Rate control (digoxin, amiodarone)
Diuretics
ACE inhibitors

68
Q

Aortic Stenosis: Valve Replacement (SAVR vs TAVR)

Surgical Mechanical Valves: More _____, but require lifetime ________

Surgical Tissue Valves: Less ________, but no _________ required

SAVR requires open heart surgery and is not optimal for _____ _______ patients

TAVR: No open heart surgery, higher risk of _____, but more optimal for high-risk patients

A

Aortic Stenosis: Valve Replacement (SAVR vs TAVR)

Surgical Mechanical Valves: More DURABLE, but require lifetime ANTICOAGULATION

Surgical Tissue Valves: Less DURABLE, but no ANTICOAGULATION required

SAVR requires open heart surgery and is not optimal for HIGH-RISK patients

TAVR: No open heart surgery, higher risk of STROKE, but more optimal for high-risk patients

69
Q

Aortic Regurgitation is when aortic valve does not ______ ________ and blood flows back into the _____

LV has to deal with normal amount of blood + extra blood that did not exit the heart = increased _______ = ventricle will ________ and ________ and overtime go into LV ___________

________ murmur

Treatment: CCB, BB, AVR

A

Aortic Regurgitation is when aortic valve does not CLOSE TIGHTLY and blood flows back into the LV

LV has to deal with normal amount of blood + extra blood that did not exit the heart = increased WORKLOAD = ventricle will HYPERTROPHY and DILATE and overtime go into LV HEART FAILURE

DIASTOLIC murmur

Treatment: CCB, BB, AVR

70
Q

MITRAL STENOSIS:

Recurrent damage to the mitral valve causes blood flow across the MV to the ____ to be _____

This increases pressure in the ______ causing blood to back up into the _______ circulation

Chronic congestion will lead to ______ dilation which may lead to _______ __________

_________ murmur

Treatment: ______ control, _________ for a-fib, diuretics, and avoid strenuous activity

1) Percutaneous mitral balloon valvotomy
2) Commissurotomy
3) Mitral Valve Replacement

A

MITRAL STENOSIS:

Recurrent damage to the mitral valve causes blood flow across the MV to the LV to be REDUCED

This increases pressure in the ATRIA causing blood to back up into the PULMONARY circulation

Chronic congestion will lead to ATRIAL dilation which may lead to ATRIAL FIBRILLATION

DIASTOLIC murmur

Treatment: HR control, ANTICOAGULANTS for a-fib, diuretics, and avoid strenuous activity

1) Percutaneous mitral balloon valvotomy
2) Commissurotomy
3) Mitral Valve Replacement

71
Q

Left Atrial Appendage:

Out-pouching of ____ that allows atria to dilate and become _____ if necessary

Blood can ____ in this area

Surgeons may do __________ to remove it and reduce the risk of stroke during mitral valve replacement

A

Left Atrial Appendage:

Out-pouching of LA that allows atria to dilate and become LARGER if necessary

Blood can CLOT in this area

Surgeons may do LIGATION to remove it and reduce risk of stroke during mitral valve replacement

72
Q

Mitral Regurgitation:

The mitral valve does not close properly and blood backflows into ____

Overtime, LA ______ and ________

________ murmur

Treatment: Treat the _____ - stage ___ is the only stage where MVR is recommended

A

Mitral Regurgitation:

The mitral valve does not close properly and blood backflows into LA

Overtime, LA STRETCH and DILATE

SYSTOLIC murmur

Treatment: Treat the CAUSE - stage D is the only stage where MVR is recommended

73
Q

PERICARDITIS:

Pericardium is a sac containing the heart and roots of great vessels

Pericarditis is _____ of this sac and causes ++ ______ _________

By definition, anyone who receives ________ _________ _______ will have pericarditis

Most common causes: recent ___ or _______ failure 2* to uremic accumulation

A

PERICARDITIS:

Pericardium is a sac containing the heart and roots of great vessels

Pericarditis is INFLAMMATION of this sac and causes ++ CHEST PAIN

By definition, anyone who receives OPEN HEART SURGERY will have pericarditis

Most common causes: recent MI or RENAL failure 2* to uremic accumulation

74
Q

Pericarditis Assessment:

Chief complaint: ______ _____
Pain is _____, sharp and positional
Increases with _______ breath
Lying on _____ or ____ will also increase pain

Patient may also be ______ and have shallowing breathing and patients are prone to _______-arrhythmias

Pericardial friction rub is present when patient is lying on ______ side. Have patient take a deep breath and hold. If still hear the rub, it is ______. If it goes away, it is ________.

A

Pericarditis Assessment:

Chief complaint: CHEST PAIN
Pain is PLEURITIC, sharp and positional
Increases with DEEP breath
Lying on BACK or LEFT SIDE will also increase pain

Patient may also be TACHYPNEIC and have shallowing breathing and patients are prone to TACHY-arrhythmias

Pericardial friction rub is present when patient is lying on LEFT side. Have patient take a deep breath and hold. If still hear the rub, it is PERICARDIAL. If it goes away, it is PLEURAL.

75
Q

What medication to use with caution with pericarditis?

A

Anticoagulants - may cause more bleeding which may lead to cardiac tamponade (pericardium is inflamed and raw)

76
Q

MYOCARDITIS:

Inflammation of the __________
Most often caused by ________ infection

Usually, resolves ________ _______ _______, but limit _____ to decrease damage as well as reduce ______ intake to decrease fluid retention

A

MYOCARDITIS:

Inflammation of the MYOCARDIUM
Most often caused by VIRAL infection

Usually, resolves ON ITS OWN, but limit ACTIVITY to decrease damage as well as reduce SALT intake to decrease fluid retention

77
Q

ENDOCARDITIS:

Inflammation of the ______ (______ of the heart), usually on the heart ______ - which often leads to ______ vegetation. These can break free and ______ to distal organs.

Infective endocarditis is usually caused by _____ in the _____ or _____ procedures. A ______ can be used to diagnose.

Patients may present with:
- Hematuria 2* _______________
- Osler nodes
- Janeway lesions
- Splinter hemorrhages

A

ENDOCARDITIS:

Inflammation of the ENDOCARDIUM (LINING of the heart), usually on the heart VALVES - which often leads to VALVE vegetation. These can break free and EMBOLIZE to distal organs.

Infective endocarditis is usually caused by BACTERIA in the BLOOD or DENTAL procedures. A TTE can be used to diagnose.

Patients may present with:
- Hematuria 2* GLOMERULARNEPHRITIS
- Osler nodes
- Janeway lesions
- Splinter hemorrhages

78
Q

MAP Calculation:

SBP + (2DBP) / 3

Normal: _____ to _____ mmHg

Tells us how well organs are being ________

A

MAP Calculation:

SBP + (2DBP) / 3

Normal: 70 to 100 mmHg

Tells us how well the body is being PERFUSED

79
Q

How might a ventricular-paced rhythm affect CO?

A

No atrial kick = decreased CO

ACU COURSE (8 decks)

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